Clinical questions - Gastroenterology Flashcards
(33 cards)
Distinguishing between upper and lower GI bleeds
UGI is typically melenic stools
LGI is typically red blood or hematochezia
Ligament of Treitz is the landmark dividing upper and lower
Most important aspect of managing an acute, large volume GI bleed
IVF resuscitation
Hypotension surpasses all other findings - you have to perfuse the body
HBsAg -
HBsAb -
HBcAB +
HBeAg -
Window period
HBsAg +
HBsAb -
HBcAB +
HBeAg +
Acute disease
HBsAg -
HBsAb +
HBcAB +
HBeAg -
Recovered
HBsAg -
HBsAb +
HBcAB -
HBeAg -
Vaccinated
Ulcerative colitis (presentation, lab markers, endoscopy findings, treatment)
Presentation: intermittently bloody diarrhea with colicky abdominal pain and fatigue
Labs: pANCA positive
Scope: continuous circumferential inflammation of the rectum that may include more proximal colon
Treatment:
Mild/all patients: 5-ASA (mesalamine) can be given orally or suppositories or enemas
More severe disease:
- Steroids
- Immunosuppressants: cyclosporine, azathioprine, 6-mercaptopurine
- Anti-TNFalpha durgs: infliximab
Colectomy is curative
Cause of diarrhea in a patient with HIV and CD4 less than 100
Cryptosporidium
Cause of diarrhea in a patient with vomiting and diarrhea after eating reheated Chinese fried rice
Bacillus cereus
Cause of diarrhea in a patient with vomiting and diarrhea after eating raw oysters
Vibrio parahaemolyticus
Cause of diarrhea in a patient with diarrhea beginning after backpacking in the mounts
Giardia lamblia
Cause of diarrhea in a patient with recent treatment for UTI
C. diff
Type of hepatitis with AST 2 times as high as ALT
Alcohol hepatitis
In general, causes of direct vs indirect hyperbilirubinemia
Direct (conjugated) bilirubin is elevated in hepatobiliary disease
Indirect (unconjugated) bilirubin is elevated in hemolysis
Crohn disease (presentation, lab markers, endoscopy, treatment)
Colicky abdominal pain, occasional low grade fevers
Lab: ASCA (Anti-Saccharomyces cerevisiae antibodies) positive (ANCAs negative)
Scope: cobblestoning and skip lesions
Path: transmural inflammation, non-caseating granulomas
Treatment: 5-ASA Steroids Immunosuppressants Anti-TNF alpha drugs
Colectomy no curative in Crohn dz
Irritable bowel syndrome
Intermittent abdominal bloating and crampy lower abdominal pain without nausea or vomiting; alternating between diarrhea and constipation with defecation often relieving the abdominal pain. No blood or mucus in stools
Tx: Avoid gas producing foods Diet low in fermentable short chain saccharides (lactose, fructose) GF diet High fiber diet Exercise
Celiac disease
Chronic diarrhea - steatorrhea
Occasional nausea/vomiting and abdominal pain
Lab markers: anti-endomysial Ab and anti-tissue transglutaminase Ab positive
GF diet: “BROW” - barley, rye, oats (often contaminated), wheat
Hereditary Hemochromatosis
AR - increased Fe absorption
Presentation: pruritis, jaundice, fatigue, infertility, joint pain, fat malabsorption
Advanced disease: skin hyperpigmentation, DM, cirrhosis
-“Bronze diabetes”
Labs: elevated Fe, ferritin, transferrin, %sat; decreased TIBC
Dx: Liver biopsy
Most common - HFE gene mutation
Tx: phlebotomy
Criteria to use ppx against stress ulcers in the ICU
Coagulopathy intubation/ventillation > 48 hrs GI ulceration/bleeding within 1 yr Head trauma Spinal cord trauma burn injury
2 or more of the following: Sepsis ICU > 1 week Occult GI bleed 6 or more days Glucocorticoid tx
What infectious risk is associated with PPIs and H2 blockers
C diff risk increased
Acute pancreatitis: presentation, an Initial lab testing, an Initial lab testing, management
Presentation: epigastric pain, nausea, vomiting, anorexia
Exam: epigastric tenderness without guarding, may have ecchymosis at bilateral flanks (Grey-turner sign) or at umbilicus ( Cullen sign)
Lab: elevated serum lipase
Management: Admit +/- ICU Monitor for hemodynamic instability and organ failure Aggressive hydration NPO Pain control (morphine) Established underlying cause
If worsening, CT A/P to r/o pseudocyst
Common causes of pancreatitis
Most common - gallstone
Alcohol abuse
Medications
Elevated triglycerides
Causes of cirrhosis and portal vein hypertension
Alcohol abuse Chronic hepatitis B or C Fatty liver disease Hemachromatosis Chronic biliary obstruction Chronic cholestasis
Exam findings consistent with cirrhosis
Jaundice, spider angiomata, gynecomastia, abdominal distention with shifting dullness and a fluid wave
